MEDICARE: HANY BASTA, M.D., PROFESSIONAL CORPORATION

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207L00000X	Anesthesiology Physician	A54439	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	6755130	OTHER	CA	PIN MEDI-CAL #
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1710087697
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HANY BASTA, M.D., PROFESSIONAL CORPORATION

Provider Business Mailing Address
First Line	:	225 S LAKE AVE
Second Line	:	535
City	:	PASADENA
State	:	CA
Zip	:	91101-3005
Country	:	US
Telephone Number	:	626-795-6596
Fax Number	:	626-795-8247

Provider Business Practice Location Address
First Line	:	2200 W 3RD ST
Second Line	:	120
City	:	LOS ANGELES
State	:	CA
Zip	:	90057-1932
Country	:	US
Telephone Number	:	213-207-5635
Fax Number	:	213-207-5889

Authorized Official
Title or Position	:	PRESIDENT
Name	:	HANY BASTA
Credential	:	M.D.
Telephone Number	:	626-795-6596

Provider Enumeration Date	:	09/22/2006
Last Update Date	:	02/27/2008

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Directions to “HANY BASTA, M.D., PROFESSIONAL CORPORATION ” Practice Location

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